Serum triglyceride and LDL cholesterol levels would be the best predictors of cardiovascular risk. Blood glucose level may help identify type 2 diabetes, which often coexists with cardiovascular disease but is not necessarily predictive of it. Serum sodium levels do not demonstrate cardiovascular risk. Blood oxygen and carbon dioxide levels would reflect lung function. Serum total and HDL cholesterol levels would be somewhat related to cardiovascular risk, but less so than triglycerides and LDL cholesterol.

2. If gangrene develops in a patients foot and the patient is found to have high blood lipid levels, he or she probably has

a.

type 2 diabetes mellitus.

b.

peripheral artery disease.

c.

angina pectoris.

d.

fatty liver disease.

ANS: B

Peripheral artery disease is a form of cardiovascular disease in which atherosclerosis develops in major arteries and blocks blood flow to the extremities. This may lead to ischemic necrosis of extremities and even gangrene; elevated blood lipids levels would indicate that this is the case. Type 2 diabetes may cause nerve damage in the extremities, and gangrene could occur, but blood lipids are not necessarily elevated. Angina pectoris is caused by atherosclerosis in the coronary arteries, and fatty liver disease is caused by excess alcohol intake or obesity.

3. If a patient has a thrombosis in a cerebral artery, he or she would experience

a.

a stroke.

b.

a migraine headache.

c.

a heart attack.

d.

angina pectoris.

ANS: A

If a patient has a thrombosis in a cerebral artery, he or she would experience a stroke, or cerebrovascular accident. A migraine headache is thought to be caused by dilation of blood vessels in the brain. Heart attacks are caused by a thrombosis in a coronary artery that completely blocks the artery. Angina pectoris is caused by a thrombus in the coronary artery that causes only partial occlusion of the blood vessel.

4. A patient who would be likely to have elevated serum triglyceride levels is a(n)

a.

single mother who works full-time and eats only two meals a day.

b.

teenager taking antibiotics during recovery from a streptococcal infection.

c.

overweight man who drinks three alcoholic beverages a day.

d.

young man infected with hepatitis A virus.

ANS: C

Elevations in serum triglyceride levels are associated with long-term excessive alcohol intake (more than two drinks per day for a man), overweight and obesity, physical inactivity, cigarette smoking, and very high carbohydrate intake. Serum triglyceride levels are not related to meal frequency, use of antibiotics, or hepatitis A infection.

5. The primary goal of therapy to reduce risk of cardiovascular disease is to lower serum levels of _____ cholesterol.

a.

total

b.

LDL

c.

HDL

d.

very-low-density lipoprotein (VLDL)

ANS: B

The primary goal of therapy to reduce risk of cardiovascular disease focuses on lowering blood levels of LDL cholesterol. Lowering serum total cholesterol and VLDL cholesterol levels and increasing HDL cholesterol levels also decreases cardiovascular risk but are not the main focus.

6. In a 55-year-old woman, an LDL cholesterol level of 195 mg/dL would be considered

a.

normal.

b.

borderline high.

c.

high.

d.

very high.

ANS: D

A serum LDL cholesterol level in excess of 190 mg/dL is considered very high. LDL cholesterol levels of 160 to 189 mg/dL are considered high; levels of 130 to 159 mg/dL, borderline high; levels of 100 to 129 mg/dL, normal; and levels lower than 100 mg/dL, optimal.

A serum triglyceride level of 175 mg/dL is considered borderline high. Serum triglyceride levels lower than 150 mg/dL are considered normal; levels of 150 to 199 mg/dL, borderline high; levels of 200 to 499 mg/dL, high; and levels in excess of 500 mg/dL, very high.

8. For a person who is implementing therapeutic lifestyle changes (TLCs) to reduce his or her risk of coronary heart disease, the best salad choice would be

a.

coleslaw.

b.

mixed greens with olive oil vinaigrette and walnuts.

c.

sliced tomatoes with basil vinaigrette and feta cheese.

d.

fruit salad with yogurt dressing and coconut.

ANS: B

TLC recommendations include focusing on sources of monounsaturated fat, such as olive oil and walnuts, and decreasing intake of saturated fat. Coleslaw contains mayonnaise, which is likely to be made with an oil high in polyunsaturated fat; the kind of oil in basil vinaigrette is uncertain, and feta cheese contains saturated fats. Yogurt dressing is not high in fat, but any fat it does contain is saturated; coconut also contains saturated fat.

9. Of the following, the most helpful change to decrease blood LDL cholesterol levels wouldbe to

a.

eat oatmeal instead of a bagel for breakfast.

b.

use fresh rather than canned vegetables.

c.

use margarine instead of butter.

d.

eat a salad instead of a sandwich for lunch.

ANS: A

Switching to oatmeal instead of a bagel for breakfast would increase intake of soluble fiber, which can significantly lower the serum LDL cholesterol level. Using fresh instead of canned vegetables would decrease sodium intake, which would help decrease blood pressure but would not affect serum lipid levels. Using margarine instead of butter may or may not be beneficial, depending on the type of oil the margarine is made from, the degree of hydrogenation, and whether it contains added stanols. Eating a salad instead of a sandwich could increase blood LDL cholesterol levels, depending on the amount and type of dressing and cheese.

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10. A patient with high serum LDL cholesterol levels tells you that he usually eats a granola bar and a cup of coffee on the way to work; eats a grilled cheese sandwich and chips for lunch; eats a home-cooked meal for dinner, which is usually a chicken dish with potatoes or pasta and frozen vegetables; and snacks on popcorn and pretzels. The most beneficial change for him to make to lower his LDL cholesterol levels would be to

Cheese has high levels of saturated fat, and grilled cheese sandwiches are often made with butter (which also has high levels of saturated fat) or margarine (which may have high levels of saturated fat), and so switching to a turkey sandwich would help decrease saturated fat intake and lower LDL cholesterol levels. Using fresh instead of frozen vegetables makes no difference other than taste. Drinking decaffeinated instead of regular coffee will not affect serum lipid levels. Eating unsalted pretzels and popcorn would help decrease blood pressure but not blood lipids.

11. A dietary change that is likely to have a significant effect on reducing the risk of coronary heart disease is

a.

snacking on tortilla chips instead of peanuts.

b.

drinking decaffeinated coffee instead of regular coffee.

c.

switching from cornflakes to oatmeal for breakfast.

d.

choosing a fast-food fish sandwich instead of a hamburger.

ANS: C

Switching from cornflakes to oatmeal for breakfast is likely to have a significant effect on reducing risk of coronary heart disease because this change will increase intake of soluble fiber. Snacking on tortilla chips instead of peanuts would increase intake of polyunsaturated fat and decrease intake of monounsaturated fat, which would probably not affect LDL cholesterol levels and may decrease HDL cholesterol levels. Drinking decaffeinated coffee instead of regular coffee is not beneficial for most people. Choosing a fast-food fish sandwich instead of a hamburger could result in increased total fat intake because the fish is fried; intake of saturated and unsaturated fats depends on the fat used for frying and any sauces added.

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12. The first step in therapy to reduce the risk for coronary heart disease is

a.

therapeutic lifestyle change.

b.

stress reduction.

c.

use of LDL cholesterol-lowering medications.

d.

use of antithrombotic medications.

ANS: A

The first step in therapy to reduce the risk for coronary heart disease is therapeutic lifestyle change (TLC), including diet and physical activity. Cholesterol-lowering medications may be added later if necessary to achieve further reductions in LDL cholesterol. Antithrombotic medications are not used routinely (they are sometimes used to reduce risk of blood clots). Stress reduction can help decrease cardiac risk but is not the first step.

13. If a patient has an initial LDL cholesterol level of 180 mg/dL and implements TLC dietary changes, and if after 6 weeks the serum LDL cholesterol level has decreased only to 165 mg/dL, the patient should

Drug therapy should be initiated only if TLC recommendations are unsuccessful in achieving health LCL cholesterol levels after 3 months; therefore, the patient should continue to implement the dietary changes. The DASH diet pattern is intended to decrease high blood pressure, not high lipid levels.

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14. Primary or essential hypertension is caused by

a.

unknown factors.

b.

sedentary lifestyle.

c.

excess sodium intake.

d.

being overweight or obese.

ANS: A

The causes of primary and essential hypertension are unknown. Sedentary lifestyle, excess sodium intake, and being overweight or obese all contribute to hypertension and are all factors that can be modified to decrease blood pressure.

16. An example of a dietary change that may help decrease risk of hypertension is

a.

eating oatmeal instead of toast and honey.

b.

eating popcorn instead of pretzels.

c.

using olive oil instead of butter.

d.

drinking skim milk instead of soda.

ANS: D

Increasing intake of foods rich in potassium, magnesium, and calcium, such as milk, can help decrease risk of hypertension. Eating oatmeal instead of toast and honey would increase intake of soluble fiber, and using olive oil instead of butter would increase intake of monounsaturated fat and decrease intake of saturated fat; both of these changes would decrease cardiovascular risk but not blood pressure. Eating popcorn instead of pretzels would increase intake of dietary fiber, which is beneficial for overall health but not for lowering blood pressure.

17. If a middle-aged man has high blood pressure, has a sedentary lifestyle, is about 30 pounds overweight, eats mostly processed food, and drinks two alcoholic beverages most days, the most effective way for him to lower his blood pressure is to

a.

reduce his sodium intake.

b.

achieve and maintain a healthy weight.

c.

participate in aerobic exercise every day.

d.

abstain from drinking alcoholic beverages.

ANS: B

The most effective way for him to lower his high blood pressure would be to achieve and maintain a healthy weight. Reducing sodium intake, participating in aerobic exercise every day, and abstaining from drinking alcoholic beverages would also help lower his blood pressure, but to a lesser extent.

In America, most dietary sodium comes from salt added to foods during processing. Processed foods often contain more sodium than when foods are prepared from scratch at home; in addition, intake of processed foods is high. Therefore, salt added at the table and salt added to foods during cooking contribute less to overall salt intake. Most natural foods contain relatively little sodium.

19. The main purpose of nutrition therapy for patients who have just experienced a myocardial infarction is to decrease

a.

blood pressure.

b.

the risk of blood clotting.

c.

LDL cholesterol levels.

d.

the workload of the heart.

ANS: D

Immediately after a myocardial infarction, nutrition therapy is designed to decrease the workload of the heart. Long-term nutrition therapy may focus on decreasing LDL cholesterol levels and blood pressure. Risk of blood clotting is controlled with medications rather than through diet.

20. If a patient had a myocardial infarction on Monday, by Thursday he or she should be eating

a.

a clear liquid diet.

b.

mostly cold foods.

c.

small, frequent meals.

d.

three moderate meals a day.

ANS: C

One or 2 days after a myocardial infarction, patients probably best tolerate small, frequent meals. A clear liquid diet is used only during the first 24 hours after a myocardial infarction. There is no reason to eat mostly cold foods. Three moderate meals a day would place a greater oxygen demand on the heart than would smaller, more frequent meals.

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21. The patient who benefit most from a sodium restriction of 2000 mg/day is one with

a.

severe heart failure.

b.

stage 1 hypertension.

c.

cystic fibrosis.

d.

chronic obstructive pulmonary disease.

ANS: A

Patients with severe heart failure require strict restriction of dietary sodium intake to reduce extracellular fluid. Patients with hypertension also benefit from sodium restriction (<2300 mg/day), but the restriction is less critical. Patients with cystic fibrosis actually need extra sodium intake; restriction could be dangerous. Patients with chronic obstructive pulmonary disease need to focus on eating sufficient calories and protein more than on restricting sodium intake.

22. If a patient with congestive heart failure tells you that he or she is being careful to eat high-protein foods throughout the day, you would also want to encourage him or her to

a.

include food sources of potassium, calcium, and magnesium.

b.

ensure that his or her overall energy intake is adequate.

c.

use oils rich in essential fatty acids.

d.

increase the fluid intake to 3 L per day.

ANS: B

It is important to make sure that patients with cardiac cachexia have adequate intakes of energy so that protein can be used to prevent further catabolism rather than being broken down for energy. Foods with high levels of potassium, calcium, and magnesium can help decrease high blood pressure but do not have a specific benefit for patients with heart failure. Oils rich in essential fatty acids are beneficial for overall health but also have no specific benefit for patients with heart failure. Fluid intake may sometimes need to be restricted for patients with heart failure to prevent fluid overload.

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23. The best time to begin to adopt heart-healthy eating habits is during

a.

childhood, to establish a lifelong healthy lifestyle.

b.

adolescence, because most teenagers have poor eating habits.

c.

young adulthood, once development is complete.

d.

middle adulthood, when coronary heart disease begins to develop.

ANS: A

The best time to begin to adopt heart-healthy eating habits is during childhood, when lifelong eating habits are being established. It is beneficial to begin healthy eating habits at any age, but it is not necessary to wait until poor habits have developed or until coronary heart disease begins to develop. Severe food restrictions should be avoided in children and adolescents to ensure adequate kilocalorie and nutrient intakes for growth and development. However, children and adolescents can still learn to choose foods and develop habits that will maintain optimal heart health throughout their life.

25. If a patient with chronic obstructive pulmonary disease (COPD) has lost 30 lb in a year and now weighs 132 lb (60 kg), the amount of protein they would need to replenish their protein stores is _____ g/day.

a.

48 to 60

b.

72 to 114

c.

96 to 150

d.

120 to 180

ANS: C

Malnourished patients with COPD need 1.6 to 2.5 g of protein per kilogram of body weight to replenish protein stores. For this patient, the amount ranges from 1.6 60 g/kg to 2.5 60 g/kg, or 96 to 150 g/day. If patients with COPD are not malnourished, they need 1.2 to 1.9 g/kg.

26. If a patient with COPD normally eats a sandwich for lunch and wants to decrease his or her respiratory quotient (RQ), he or she could

a.

add extra mayonnaise and remove some of the bread.

b.

remove the cheese and add lettuce and tomato.

c.

add extra lean meat and use mustard instead of mayonnaise.

d.

use whole-grain bread and add spinach.

ANS: A

RQ is lower when the proportion of energy intake from fat is higher and the proportion of energy intake for carbohydrate is lower; therefore, adding mayonnaise and removing bread would increase the ratio of fat to carbohydrate. Removing cheese and using mustard instead of mayonnaise would actually decrease fat and increase RQ. Lettuce, tomatoes, and spinach contain very little energy and would have very little effect on RQ. Whole-grain bread would add dietary fiber, which does not affect RQ. Adding extra lean meat would add protein but would have little effect on the proportion of fat and carbohydrate.

27. If a patient with cystic fibrosis has diarrhea and is losing weight, it would be most important to evaluate whether the

a.

pancreatic enzyme replacement therapy is adequate.

b.

patient has developed an eating disorder.

c.

patient is drinking adequate fluids to maintain good hydration.

d.

patient is struggling with loss of appetite.

ANS: A

Patients with cystic fibrosis require individualized pancreatic enzyme replacement therapy because their pancreatic ducts often become obstructed by viscous secretions; inadequate enzyme replacements cause malabsorption, diarrhea, and weight loss. Patients with cystic fibrosis need large amounts of food to maintain weight and do not usually develop eating disorders. They do not usually struggle with maintaining hydration or with loss of appetite.

Patients with cystic fibrosis require a high-kilocalorie diet to compensate for high metabolic rate and malabsorption, multivitamin supplements to compensate for malabsorption, and enzyme replacement therapy to increase digestion and absorption of nutrients. A low-fat, low-energy diet would result in malnutrition. In cystic fibrosis, secretion of enzymes is impaired, but hormone production is normal. A high-fiber diet does not have any specific benefit for this population. Diuretics are not needed and could be dangerous because of excessive electrolyte losses. Sodium intake should be liberal, rather than restricted. Protein intake may exceed the Dietary Reference Intake (DRI), but needs are met by increased food intake.

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29. One of the most important strategies for coping with the reality of a serious chronic disease such as cystic fibrosis is

a.

having a sense of humor.

b.

avoiding talking about it.

c.

making friends only with others who have the same disease.

d.

making friends only with others who do not have the same disease.

ANS: A

A sense of humor is a helpful coping mechanism for patients with chronic diseases such as cystic fibrosis. Avoiding talking about it simply magnifies fears and causes isolation. It is probably helpful for patients to have friends who have the disease who can identify with its struggles; friends who do not have the disease who can provide a sense of normality.

30. For an infant with cystic fibrosis, the greatest concern would be if the mother wanted to

a.

bottle feed her infant with formula.

b.

pump breast milk and bottle feed the infant.

c.

breastfeed without using enzyme supplements.

d.

employ a nanny to care for the child during the day.

ANS: C

Infants with cystic fibrosis may be breastfed or fed infant formula along with enzyme replacement therapy; if the mother wanted to breastfeed exclusively and was unwilling to use enzyme replacement therapy or supplements, the infant would become severely malnourished. Attending daycare may be a concern because of increased risk of infection, but employing a nanny should not pose a significant risk.

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31. If a ventilator-dependent patient with acute respiratory failure does not receive sufficient protein and energy from enteral feedings, the most serious consequence is that the

a.

chest muscles may not be strong enough for weaning from the ventilator.

b.

patient will lose muscle tone.

c.

gut will lose integrity, and bacterial translocation may occur.

d.

patient may develop essential fatty acid deficiency.

ANS: A

If patients with acute respiratory failure do not receive sufficient energy and protein, the protein in their chest muscles may be used for energy and they may be too weak to be weaned from the ventilator. They may lose some muscle tone, but this is less problematic. As long as they are receiving some enteral nutrition, they should be able to maintain gut integrity. Essential fatty acid deficiency is not necessarily caused by inadequate intake of protein and energy.

32. When using parenteral nutrition support for patients with acute respiratory failure, it is important to avoid use of high glucose concentrations because

a.

glucose tolerance is often impaired.

b.

they may cause hypersecretion of insulin.

c.

they increase RQ.

d.

they may lead to development of diabetes mellitus.

ANS: C

Parenteral nutrition support for patients with acute respiratory failure should not include high glucose concentrations because they result in excess carbon dioxide production, which increases RQ. Lipids should be used to provide a significant proportion of nonprotein kilocalories (1 to 2 g of lipid per kilogram of body weight). Glucose tolerance is not affected by respiratory failure. Infusion of high concentrations of glucose does not cause hypersecretion of insulin or lead to development of diabetes mellitus.